Otolaryngology Coding Alert

Question: When should I use 92504? Would you give an example showing appropriate 92504 reporting?

North Carolina Subscriber

Answer: PT designates binocular microscopy as a "separate procedure." So you should report 92504 (Binocular microscopy [separate diagnostic procedure]) only when your otolaryngologist:

1. performs no other codeable ear procedure during the same visit.

Example: An otolaryngologist suspects a foreign body in a patient's ear, looks in the ear and doesn't find a FB. Because no object was found and removed, you should code the look-see (92504). If he had removed a foreign body from the external auditory canal, you would instead code the FB removal (69200, Removal foreign body from external auditory canal; without general anesthesia).

Similarly, you should report 92504 for placing an earwick because no code exists for the procedure.

2. uses the binocular microscope and performs an unrelated procedure.

Example: An ENT looks in a patient's ear and also performs a nasal endoscopy. Because the look-see and scope occur on separate body areas, you should report both procedures. Append modifier 59 (Distinct procedural service) to 92504 to indicate the microscopy as a distinct procedural service from 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]).